Tissue engineering in the treatment of cartilage lesions

  • Jakob Naranđa Univerzitetni klinični center (UKC) Maribor, Oddelek za ortopedijo, Ljubljanska 5, 2000 Maribor
  • Matjaž Vogrin Univerzitetni klinični center (UKC) Maribor, Oddelek za ortopedijo, Ljubljanska 5, 2000 Maribor
Keywords: cartilage regeneration and chondrogenesis, tissue engineering, scaffolds (cell carriers), growth factors (GF), stem cells, bioreactors


Background: Articular cartilage lesions with the inherent limited healing potential are difficult to treat and thus remain a challenging problem for orthopaedic surgeons. Regenerative treatment techniques, such as autologous chondrocyte implantation (ACI), are promising as a treatment option to restore hyaline-like cartilage tissue in damaged articular surfaces, as opposed to the traditional reparative procedures (e.g. bone marrow stimulation – microfracture), which promote a fibrocartilage formation with lower tissue biomechanical properties and poorer clinical results. ACI technique has undergone several advances and is constantly improving. The new concept of cartilage tissue preservation uses tissue-engineering technologies, combining new biomaterials as a scaffold, application of growth factors, use of stem cells, and mechanical stimulation. The recent development of new generations of ACI uses a cartilage-like tissue in a 3-dimensional culture system that is based on the use of biodegradable material which serves as a temporary scaffold for the in vitro growth and subsequent implantation into the cartilage defect. For clinical practice, single stage procedures appear attractive to reduce cost and patient morbidity. Finally, modern concept of tissue engineering facilitates hyaline-like cartilage formation and a permanent treatment of cartilage lesions.

Conclusion: The review focuses on innovations in the treatment of cartilage lesions and covers modern concepts of tissue engineering with the use of biomaterials, growth factors, stem cells and bioreactors, and presents options for clinical use.


Download data is not yet available.


Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13: 456–60.

Hoffmann A, Gross G. Innovative strategies for treatment of soft tissue injuries in human and animal athletes. Med Sport Sci 2009; 54: 150–65.

Detterline AJ, Goldberg S, Bach BR, Jr., Cole BJ. Treatment options for articular cartilage defects of the knee. Orthop Nurs 2005; 24: 361–6.

Lewis PB, McCarty LP, 3rd, Kang RW, Cole BJ. Basic science and treatment options for articular cartilage injuries. J Orthop Sports Phys Ther 2006; 36: 717–27.

Nazem K, Safdarian A, Fesharaki M, Moulavi F, Motififard M, Zarezadeh A, et al. Treatment of full thickness cartilage defects in human knees with Autologous Chondrocyte Transplantation. J Res Med Sci 2011; 16: 855–61.

Harris JD, Siston RA, Pan X, Flanigan DC. Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am 2010; 92: 2220–33.

Giannoni P, Cancedda R. Articular chondrocyte culturing for cell-based cartilage repair: needs and perspectives. Cells Tissues Organs 2006; 184: 1–15.

Aigner T, Sachse A, Gebhard PM, Roach HI. Osteoarthritis: pathobiology-targets and ways for therapeutic intervention. Adv Drug Deliv Rev 2006; 58: 128–49.

Bruckner P, van der Rest M. Structure and function of cartilage collagens. Microsc Res Tech. 1994; 28: 378–84.

Hayes DW, Jr., Brower RL, John KJ. Articular cartilage. Anatomy, injury, and repair. Clinics in podiatric medicine and surgery. [Review]. 2001; 18: 35–53.

Uchio Y, Ochi M. Biology of articular cartilage repair—present status and prospects. Clinical calcium 2004; 14: 22–7.

Redman SN, Oldfield SF, Archer CW. Current strategies for articular cartilage repair. Eur Cell Mater 2005; 9: 23–32.

Hildner F, Albrecht C, Gabriel C, Redl H, van Griensven M. State of the art and future perspectives of articular cartilage regeneration: a focus on adipose-derived stem cells and platelet-derived products. J Tissue Eng Regen Med 2011; 5: e36–51.

Radosavljevič D DM, Gorenšek M, Koritnik B, Kregar-Velikovanja N. Operativno zdravljenje okvar sklepnega hrustanca v sklepu. Med Razgl 2003, 42: 47–57.

Drobnic M, Kregar-Velikonja N, Radosavljevic D, Gorensek M, Koritnik B, Malicev E, et al. The outcome of autologous chondrocyte transplantation treatment of cartilage lesions in the knee. Cellular & molecular biology letters 2002; 7: 361–3.

Minas T. Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop Relat Res 2001:S349–61.

Stock UA, Vacanti JP. Tissue engineering: current state and prospects. Annu Rev Med 2001; 52: 443–51.

Elder BD, Athanasiou KA. Synergistic and additive effects of hydrostatic pressure and growth factors on tissue formation. PLoS One 2008; 3: e2341.

Barlic A, Drobnic M, Malicev E, Kregar-Velikonja N. Quantitative analysis of gene expression in human articular chondrocytes assigned for autologous implantation. J Orthop Res. 2008; 26: 847–53.

Malicev E, Barlic A, Kregar-Velikonja N, Strazar K, Drobnic M. Cartilage from the edge of a debrided articular defect is inferior to that from a standard donor site when used for autologous chondrocyte cultivation. J Bone Joint Surg Br 2011; 93: 421–6.

Arora NS, Ramanayake T, Ren YF, Romanos GE. Platelet-rich plasma in sinus augmentation procedures: a systematic literature review: Part II. Implant Dent 2010; 19: 145–57.

Pei M, He F, Vunjak-Novakovic G. Synovium-derived stem cell-based chondrogenesis. Differentiation 2008; 76: 1044–56.

Cals FL, Hellingman CA, Koevoet W, Baatenburg de Jong RJ, van Osch GJ. Effects of transforming growth factor-beta subtypes on in vitro cartilage production and mineralization of human bone marrow stromal-derived mesenchymal stem cells. J Tissue Eng Regen Med. 2012; 6: 68–76.

Rui YF, Du L, Wang Y, Lui PP, Tang TT, Chan KM, et al. Bone morphogenetic protein 2 promotes transforming growth factor beta3-induced chondrogenesis of human osteoarthritic synovium--derived stem cells. Chin Med J (Engl). 2010; 123: 3040–8.

Mauck RL, Nicoll SB, Seyhan SL, Ateshian GA, Hung CT. Synergistic action of growth factors and dynamic loading for articular cartilage tissue engineering. Tissue Eng 2003; 9: 597–611.

Sun L, Wang X, Kaplan DL. A 3D cartilage–inflammatory cell culture system for the modeling of human osteoarthritis. Biomaterials 2011; 32: 5581–9.

Hutmacher DW, Goh JC, Teoh SH. An introduction to biodegradable materials for tissue engineering applications. Ann Acad Med Singapore 2001; 30: 183–91.

Moutos FT, Guilak F. Composite scaffolds for cartilage tissue engineering. Biorheology 2008; 45: 501–12.

Kramer J, Hegert C, Guan K, Wobus AM, Muller PK, Rohwedel J. Embryonic stem cell-derived chondrogenic differentiation in vitro: activation by BMP-2 and BMP-4. Mech Dev 2000; 92: 193–205.

Ronziere MC, Perrier E, Mallein-Gerin F, Freyria AM. Chondrogenic potential of bone marrow- and adipose tissue-derived adult human mesenchymal stem cells. Biomed Mater Eng 2010; 20: 145 58.

Nakayama N, Duryea D, Manoukian R, Chow G, Han CY. Macroscopic cartilage formation with embryonic stem-cell-derived mesodermal progenitor cells. J Cell Sci 2003; 116: 2015–28.

Richardson SM, Hoyland JA, Mobasheri R, Csaki C, Shakibaei M, Mobasheri A. Mesenchymal stem cells in regenerative medicine: opportunities and challenges for articular cartilage and intervertebral disc tissue engineering. J Cell Physiol 2010; 222: 23–32.

Shieh AC, Athanasiou KA. Principles of cell mechanics for cartilage tissue engineering. Ann Biomed Eng 2003; 31: 1–11.

Grad S, Eglin D, Alini M, Stoddart MJ. Physical stimulation of chondrogenic cells in vitro: a review. Clin Orthop Relat Res 2011; 469: 2764–72.

Sun M, Lv D, Zhang C, Zhu L. Culturing functional cartilage tissue under a novel bionic mechanical condition. Med Hypotheses 2010; 75: 657–9.

Harris JD, Siston RA, Brophy RH, Lattermann C, Carey JL, Flanigan DC. Failures, re-operations, and complications after autologous chondrocyte implantation—a systematic review. Osteoarthritis Cartilage 2011; 19: 779–91.

Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J. Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc 2010; 18: 519–27.

Hettrich CM, Crawford D, Rodeo SA. Cartilage repair: third-generation cell-based technologies—basic science, surgical techniques, clinical outcomes. Sports Med Arthrosc 2008; 16: 230–5.

Schiavone Panni A, Cerciello S, Vasso M. The manangement of knee cartilage defects with modified amic technique: preliminary results. Int J Immunopathol Pharmacol 2011; 24: 149–52.

McCormick F, Yanke A, Provencher MT, Cole BJ. Minced articular cartilage—basic science, surgical technique, and clinical application. Sports Med Arthrosc. [Review]. 2008; 16: 217–20.

How to Cite
Naranđa J, Vogrin M. Tissue engineering in the treatment of cartilage lesions. ZdravVestn [Internet]. 1 [cited 17Sep.2019];82(10). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/962